Brandy Smuzeski - Senior Health Care | Avoid the Last Minute Emergency

Do you want to live a long and healthy life?

Preventable Services, Annual Wellness Visits, and Advanced Care Planning can make a world of difference in the quality and length of our lives.

Prevention is often cheaper than cure.

Preventive health care is an important part of living well. By getting regular check-ups and screenings, you can help prevent illness or detect it early when treatment works best.

Annual wellness visits are the foundation of preventive health care. They’re also a great opportunity for your doctor to get to know you and your family, discuss any concerns, and develop personalized prevention strategies that meet your needs.

You can also use these services to help your family plan for your future care needs. The more we know about what we want at the end of our lives, the better prepared we’ll be when it comes time to talk with loved ones about how they should handle things if something happens to us.

It’s never too early (or late) to start planning for your future care needs!
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Bio:

Brandy Smuzeski is a licensed master social worker and Certified Alcohol and Drug Counselor, who is a Clinical Manager at Medical Advantage Group. Brandy has extensive experience working with the geriatric population in both hospital and outpatient settings. She works very closely with Primary Care Physicians in identifying opportunities to meet the needs of their patients in this vulnerable demographic.

Find Brandy on LinkedIn: https://www.linkedin.com/in/brandy-smuzeski-lmsw-65121997/

Transcript

Hanh: 0:00

Hi, I'm Hanh Brown. Host of the Aging Media Show. This conversation is live streaming on the various social media platforms, whether you are watching or listening, we appreciate your time to be a part of this important discussion. So please let us know if you have any questions so that together we can learn from each other's insights and experiences. And thank you again for tuning into aging. So the topic today is avoid the last minute emergency. Do you want to live a long and healthy life preventable services? Annual wellness visits and advanced care planning can make a world of their friends in the quality and length of our lives. Prevention is often cheaper than cure. Preventative healthcare is an important part of living well. By getting regular checkouts in screaming, you can help prevent illness or detected early when treatment works best. So annual wellness visits are the foundation of preventative health care. They're also a great opportunity for your doctor to get to know you and your family. Discuss any concerns in develop personalized prevention strategies that meet. So you can also use these services to help your family plan for your future care needs. The more we know about what we want at the end of our lives, the better prepared we'll be when it comes time to talk with loved ones about how they should handle things. If something happens to us. So it's never too early or late to start planning for your future care needs. So joining me today is Brandy Smuzeski. She's a licensed master social worker and certified alcohol drug counselor, who is a clinical manager at medical advantage. Brandy has extensive experience work with the geriatric population in both hospital and outpatient settings. She works very closely with primary care physician. In identifying opportunities to meet the needs of their patients in this vulnerable demographic. So Brandy welcome to the show.

Brandy: 2:28

Thank you for having me today.

Hanh: 2:30

Great. So can you share with us something about yourself on a personal side other your work?

Brandy: 2:37

Yes. I have two beautiful daughters. I have a 22 year old as well as a 14 year old. And. They are probably my entire world. I really focus around them as well as been married happily for 17 years. And I have a mom, a mom that is 72 years old, who I worry about aging and America and aging within the healthcare system. And what that looks like for her.

Hanh: 3:02

Well, congratulations on your children, your family, and your merits. Thanks for being here and talking about the very important topic. Yeah. So I guess let's bring everybody on the same page. What is the definition of preventative services and why is it so important to invest in preventative services for seniors?

Brandy: 3:27

Yeah. So the definition of preventative services are services or care that you receive to prevent illnesses, detect medical conditions, and to keep you healthy. And it's so important to invest in the preventative services for seniors, and more specifically the elderly because preventative services are important. They're important for everyone. But with older adults, you are looking at more risk of health problems. As you increase with age, age brings a higher risk for chronic diseases, such as dementia, heart disease, type two diabetes. Arthritis and cancer. And so when you start focusing and investing in preventative services, they've been shown to reduce the progression of diseases and illnesses, reduce hospitalization as well as costs and improve overall quality of life. And as we start to get a little bit older, we start maybe emphasizing and caring more about the quality of our life. So focusing more on preventative services allows us to focus on the quality of our life. It also can assist with detecting medical conditions before they become major conditions. Thinking of having a mammogram, the goal is to detect any lumps or abnormalities before they become too sincere. And the same as when you think of colorectal cancer screening you're screening, before these become problems.

Hanh: 4:46

So true. So is there an age that someone should start looking into this? Is it, you know, how early, or is there a window of time? That is very critical.

Brandy: 4:57

Great question. And I think a lot of people tend to wait and put it off because they think they, they're not quite old enough to. Engage in preventative services. However, everyone at all ages should be taking measures to engage in preventive services. Think of a child who has an annual physical as well as receiving vaccinations. When they're younger, you start those preventative services at a young age to prevent diseases and illnesses from occurring throughout your entire life. So there's never too early. Never too never too late.

Hanh: 5:28

And how can we help with the preventative service?

Brandy: 5:33

The big thing I believe is having the understanding of why they are important. Why the physician is asking you to come in for an annual wellness visit. We often hear with some of the patients that we work with. Is I just came in. I just came in for a sore throat, a cough. I'm not sick. I don't need to come in. And what they don't realize is the importance of having the annual wellness or having a physical or the importance of that preventative service on their overall health. I think we kind of get in that mentality of, we get so busy with everyday living that we don't have time and last it becomes detrimental that we have to go to the doctor. And that's where, you know, preventative services, just having that educational component, a better understanding of why it's being asked, I think would definitely be more helpful engaging patients.

Hanh: 6:18

And a lot of the preventative services that we're talking about. Most people, most women dread doing it, you know? Yeah. Very necessary. So can you share with us, a story hands-on situation with a person, you know, of taking preventative services or their physical, mental, and dental health?

Brandy: 6:40

Yes. So we, we do some work with large groups of physicians and our primary focus for some of these physicians is on annual wellness visits, as had mentioned at the beginning, annual wellness. Are almost that key, putting your foot in the door with these preventative services, as we get a little bit older and we work with these patients in what we hear from the patients are around engaging in that preventative services is they didn't realize it was out there. They didn't understand why they were having it done or being asked to have it done until the physician brought them in and it was educating them. And then they understood how it really plays with their overall health. So really hearing from the patients and we, when we work with the physicians, we provide them with guidance directly with their patients on how to implement these annual wellness visits, to be the most successful for the patient. So we've had that direct work with the patients and we hear back from them how grateful they are, that their physicians are taking this proactive step and care about them enough to bring them into address these preventative measures that are out there and available at free or low cost for them.

Hanh: 7:45

So now, do you think that taking these measures were less than the need for care in the future? For someone who has agreed to do services when needed?

Brandy: 7:54

Absolutely. So receive receiving preventative services reduces the risk for diabetes. Disability is death. According to the U S department of health. They have even done some research on disease control of you look at the vaccinations and implement vaccinations in younger, younger children as been able to eradicate some diseases, as well as prevent some diseases and children throughout their lives. And as they get older, as well as the prevention of diseases and preventative services detect conditions prior to them becoming more sensitive, more severe. So, if you start coming in and receiving mammograms on a yearly basis, or as ordered by your physician, you can detect that lump earlier, maybe a cancer and a stage one, or stage two versing a stage four. So you're able to prevent that disease progression, which prevents that maybe those additional treatments, that if you didn't catch it early enough, you may end up with a terminal disease that you can't prevent, or you can't cure.

Hanh: 8:55

Yeah, I know on a personal level with my own sibling, we, I guess I could say I paint painfully know that experience. Okay. The CDC recommends health screenings for all adults. So what are some of the things that have been overlooked when it comes to let's say folks 65 plus for their screening?

Brandy: 9:24

Yeah. So some preventative services for health issues that have specifically emerged later in life are things around geriatric syndrome. And that would be dementia falls delirium, as well as other previously uncommon clinical states. And you're thinking of osteoporosis, maybe hypertension as, and as well as incontinence. And we tend to overlook these as people get older because they're embarrassing questions. They're embarrassing information for maybe the patients to provide back to their physician. Depression is another one where, where the physician kind of dismisses the progression. The depression as old age and not as depression. And so it goes on diagnosed and on caught when the patient comes in and they're saying why I'm lethargic, I'm sad. And haven't really wanted to get around and move my, or get out of my house. And the physician tends to sometimes dismiss it as you're getting older. You're not as mobile as you used to be, and you don't have as many opportunities to engage in activities. First thing, it may be depression with these patients. So it's just being mindful of those conditions out there that do exist. That do tend to be overlooked as well as doing cognitive functioning status on your patients during an annual wellness visit that really helps with seeing, are they becoming forgetful? Are there greater issues at it than just being stressed? There's times I forget things all the time and I, I'm not at the age of being 65 yet, but I think about, am I forgetting because I'm getting older or is there an underlying condition? You just have to make sure that you have those screenings and it's not dismissed as you're just getting older. I think those are things that tend to be over looked.

Hanh: 11:06

Yeah, very true. So what can we, I guess, where can we find more information about preventative care for retirees?

Brandy: 11:15

Absolutely. So cms.gov has a great and abundance of sites with preventative services and it is for all Medicare insurance. So that would be your managed Medicare as well as your Medicare fee for service. They, I want to say probably have a 15 loss preventative services. You can click on this nice user friendly box. And then it really goes into explaining what that preventative service is and who it is for that would provide some good insight for those retirees to have a better understanding of what's available to them.

Hanh: 11:47

Is there a link between these services and senior health care cost?

Brandy: 11:53

So I, I will say some studies out there have had some conflicting results. Some show that there is a decrease in overall costs. Others have shown that because of the preventative services that are a little bit more costly. And if a patient would not have engaged in the physical, in the preventative services, maybe there wouldn't be those associated costs with the preventative. So, when it comes to the cost associated with the preventative services back to the patient, there should be no copay to a very minimal copay associated with it. However, what they found is with preventative services, the quality of living in life tend to increase. And that is almost something you can't put a price tag on.

Hanh: 12:34

Very true now, is that the only reason why seniors should be taking advantage of preventative care plans or what do you think?

Brandy: 12:43

No. And this is the other thing with the research around the cost of preventative services in the long run, if they reduce it, because what tends to happen is those patients who engage in preventative services tend to live longer. And when you live longer, you're going to have a little bit more health associated costs with you because you're living longer than maybe someone who did not engage in preventive services. And you're living longer for a couple of different reasons. You're, you're doing those preventative services. You're probably living a more healthier lifestyle. Your behaviors are changing as well as you're being screened for these conditions prior to the conditions becoming major and becoming more costly. So yeah, you know, living that healthier longer life is definitely something that is linked to the preventative services. And then the overall increase in quality of life.

Hanh: 13:30

Very true. But do you think some seniors avoid visiting the doctor out of fear that they'll need to discuss the end of life issue?

Brandy: 13:40

I do. So I do, and I feel that there may be some people, you know, elderly, even young who have fears of those end of life discussions, and they may avoid the physician's office because they're just not quite sure. Well, that discussion is going to look like what all it entails and what exactly that discussion is. And when we talk about advanced care planning, a lot and advanced care planning, doesn't just mean end of life discussion. It doesn't mean hospice care. It means we all should be having advanced care planning discussions. We should be having this at the time that we're 18 and discussing this with our family, our friends, our physician, to make sure others are aware of our wishes. So yeah, definitely think that there's some fear that happens.

Hanh: 14:23

Yeah, I'm with part of that group that is fearful. I mean, let's face it. I procrastinate myself. I am bringing myself to get caught up, you know, with all the preventative care for discussing. I'm bringing myself to do this, especially now that you know, COVID is later part of it now. And obviously they're taking appointments more regularly on with you now, is there anything healthcare professionals can do to make new patients be more comfortable during this conversation?

Brandy: 14:56

I think the approach is probably that starting point. So looking at these conversations as advanced care planning and not the end of life planning, I think that's very important taking the time to explain what exactly. Advanced care planning is. And what it means is very important. We tend to say, come in, have this annual wellness visit done, but we're not giving no reasons why we're not giving any explanation when we know why someone's asking us to do something, we're more prone to do it. So I think explain them importance of it, talking about the importance of planning. In the event that someone is unable to make their own decisions and how that helped alleviate some of the burden off the family. So you're not just doing it because the doctor wants you to have this conversation. You could be having these conversations because it's going to help when that time comes, where you may not be able to make decisions for yourself and your families in a stressful situation, it's going to help your family know what your wishes as well.

Hanh: 15:49

Yeah, these annual wellness visit very very important. So now what might an annual wellness visit encompass or a senior and older adult? What does that look like?

Brandy: 16:01

Yeah. So the annual wellness visit will consist of a health risk assessment, which is really a self-report questionnaire, asking the patient about their health, their diet, their activity level, their prior medical conditions, medications, family history. The fall risks, identifying any home safety issues through activities of daily, living the author receive a depression screening, and this may be, you know, a PHQ two, a PHQ nine, they'll also receive a screening for any type of cognitive impairment. So that's really going to help detect any type of dementia diagnosis that might be occurring. Or when we mentioned earlier about the forgetfulness, this will really help identify, is it a cognitive impairment or is it just maybe that patient is stressed? It also will. Compass obtaining the vitals of the patient. So we'll want to know the height, the weight, their blood pressure may also have a screen of vision. Acuity screening will be performed. That's usually performed in the very first one. And then they'll also be provided with the opportunity to discuss about advanced care planning. However, this is at the discretion of the patient. They do not have to have that conversation, but it would be offered during the annual wellness. And then any education in counseling, as well as referrals needed to the patient based on their health risk assessment, if there was anything identified there, the physician may also order some labs if they want outside of the annual wellness visit, just as part of that prevention of other diagnosis. And then the patient would also receive a five to 10 year prevention plan to let them know when they're due for their next mammogram of the colorectal cancer screening and have that plan for the future to be able to run.

Hanh: 17:35

So, how do you recommend the senior prepare or their annual wellness visit? What should they do?

Brandy: 17:43

Yes. So the best way for them to prepare is to have a list of their medical medications, their current physicians that they're seeing our specialists have that wrote down, keep it in their wallet, their purse, their pocket, somewhere. When they go to the physicians office, they're able to pull out this list instead of trying to remember it, as well as instead of bringing that bag of medications, if they're able to write down each of their medication, On a single paper, that would be less likely for them to take a medication, lose it, forget to put it back where they need to take it the next day. And then any questions they may have about the annual wellness visit. Some patients are not as familiar with what an annual wellness visit is or what all it entails. So just creating that list in advance will help them. So they don't forget to ask a question that maybe they were thinking about prior.

Hanh: 18:27

So how often should this happen? And what's the best way to track the health and well being of the seniors?

Brandy: 18:34

So what should happen every 12 months, if you go in to the office and you have an annual wellness visit done in December of this year, you would be eligible for another one December of the next year. We do encourage allow the physicians to schedule the following year. So if you come in December, this year, Let your physician know, or we're also educating the physicians, go ahead and schedule that next annual wellness visit for the following year now. So it's already on the calendars. You can send that reminder out to the patient next year, a week or two prior, and then also the day prior. So they remember, but it's already scheduled for them. So that way you're not worrying about catching up as well, coming the next year. And then to think about the best way to track the health and well being and writing down questions you have. This is one that I'm also guilty of. I think of prior to a physician's appointment, I'm going to ask my doctor X, Y, and Z. And I forget to write it down. I get there and I only asked them one of the five questions I was thinking of prior. So writing those questions down and not just writing them down, but stick it on your fridge next to your purse next to your keys next to your wallet. Somewhere that you'll remember to take it with you when you go, because that's another thing that I've done is wrote it down, left it behind. So those two, I think, are really important to remember questions that you have prior and really engage and think about the importance of preventative care. Sometimes we hear about things and we're hesitant and we say, it's not for us. Do a little research on your own if you'd like, or even ask your physician for some educational material around annual wellness visit. So, you know, in advance advanced importance, what all entails and what to expect when that time comes.

Hanh: 20:07

And, you know, what many people, myself included are very excited by the tail end of the visit. We're just excited to leave, you know, which is so relieved that it's over and until next year. Right. So, yeah, I think we all need to shift that thinking because we're doing ourselves a disservice. If you don't. Oh, I hear, you now. What recommendations can we provide to seniors to be more proactive about their health and does age really have an effect on the type of care, you know, and, and the recommended checkup that one will have and the habits that they form over time, you know what I mean?

Brandy: 20:50

Yes. So I definitely recommend all seniors, all age groups to be proactive in their health care. And that would be following up with your primary care physician. Even if you're healthy, you should at least go in once a year for a physical, if you're under 65 and you're not due for an annual wellness visit. Then you're eligible for that physical habit physical done. It has really been shown to be beneficial with identifying diseases, illnesses, or your overall life, as well as thinking about that, the fact that age has with certain type of care. Yes, it does. And we've mentioned that. The cognitive impairment, where you get the screening and the depression screening. And these are the things that come at specific ages. You know, we think about fall risks. We're not necessarily concerned with 17 year olds falling as we are with someone that's 70. So there are different screenings and there are different services, preventative services geared and targeted towards the age groups the individuals are because we know that they're more at risk of these. The same with osteoporosis. We think the bones of a 21 year old are going to be a little bit stronger and healthier than the bones of an 81 year old. So we want to be screening for those things. As somebody gets older to the age where they're more at risk purpose.

Hanh: 22:02

Very true. So do you think doctors should take more proactive measures towards covering topics like managing prescription enduring behavior treatments or making referrals to specialists during the visit?

Brandy: 22:16

Yes, I do feel more opportunity in time can focus around the continuity of care here. Behavioral health is a hot topic, but then the last year to two years, especially with the impact of COVID on the world. There, what I hear back, the feedback is there just isn't enough hours or minutes in a day to address everything. And this again is where we really support and push the annual wellness visits, because it gives you that additional time to spend with the physician to address. Medication reconciliation to discuss prior medical conditions to discuss the family history. When usually you go in to see a physician, yours might be a little bit different than mine, but usually I've got about 10 minutes, 15 minutes. And I know my time is up and I'm waiting in the waiting room for a good 45 minutes prior to that. So I know my time is limited. Usually we're only going to address what we're there for. So just thinking of those annual wellness visits could be reviewing all the. Issues that you may have to become more in depth. I also think for healthcare as a whole, we need to have more time to spend with patients. The physicians need to have more time, and I'm not sure if that's going to be something with their schedule. If that's going to be something CMS may be taking some burden off of them that they currently have to do around administrative task. But more time with the physicians needed to be able to do those matter reconciliations as well as discuss behavioral health needs and put referrals on you can place a referral. But if there's no follow-up to confirm that the patient fulfilled the referral or went to that appointment, we still don't know what happened. There's that gap there. So we want to make sure we're able to close that loop.

Hanh: 23:48

Very important. So what things do you think need to be developed in order to incur seniors to take better care of themselves?

Brandy: 23:57

I think education to me, education is number one, explaining more why the services are being asked of the patient. Why are they are going to be done? What the benefits are. So you start with what the services are explaining, you know, into detail, what the services are, why they're being performed. And when they're due, as well as maybe pulling in the families of the patients. So if the patient comes in, you have an elderly patient and they usually bring in their daughter, pulled their daughter into the examination room with the patients, except if the patient accepts that and is fine with it and discuss with them. Why the preventative services what's occurring with the patient. And again, with the permission of the patient, but bringing the family and to have that unity in that support system is really important as well. And then identify any barriers to treatment. This is one thing that I think we overlook. We hear a lot about noncompliance, this patient's non-compliant with their medication, this patient's non-compliant with their follow-up appointments, but what is the barriers that are occurring that causes the non-compliance. Is it, they cannot afford the medication is that they don't have the transportation. So what is going on there? And I just think it's an area that we need to focus more on to help improve the overall quality of life healthcare for seniors and adults.

Hanh: 25:14

Yeah. And you know what you mentioned that typically is a 10 minute visit. How do you intrust in someone, how does a senior intrust in someone and have that will for, to really dig in and speak about these concerns? You know, because it's 10 minutes and sometimes not all can be very mechanical, you know? Okay. Well, let's do a little bit of a deep dive on advanced care planning. What is it? And how do we get started with it?

Brandy: 25:44

Yeah, so advanced care planning. I think I might've mentioned earlier. It is one of the components that is offered to the patients during the annual wellness visit. However, you're free to turn it down and say, you're not interested or whatever the case may be, but advanced care planning would be a discussion about what would happen in the event that you're unable to make your own decisions. And this could be. Uh, car accident. This does not have to be about a terminal diagnosis. It could be a car accident, just something that may occur that it's unplanned unexpected. It allows for you to create a document, have discussions as well as with your family, your loved ones, your physician on what you'd like ahead of time on what those decisions might look like, whether it is, if you're in that car accident, would you want CPR? Would you want blood transfusions? Would you want. All of those things laid out. So it's aware to your family and those around you in the event that you can not make those decisions yourself, not having the conversation, doesn't avoid those things from happening. It just avoids your wishes from being known.

Hanh: 26:45

So, what do you recommend or how can clinicians help seniors talk through their preferences for future life? Any treatment? I mean, you know, professionals, we can speak like you and I are right now objective. But imagine if you're 80, how does professionals clinicians help the patients help the seniors select their preferences?

Brandy: 27:08

Yes. And I think a great starting point to generate those conversations are planned. The seat could be during those annual wellness visits and just discussing that this is an opportunity to have these conversations. If they're receptive to it. As well as providing a copy of what an advanced care planning conversation would look like for an advanced directive, providing that to the patient, to take home. And then the patient can review it at home on their own time when they have more than 10, 15, 20 minutes to spend on it. And then to come back with any questions. The other thing is connecting those patients with resources. Within the community there's commission on aging in the area that I live in that provides resources around advanced care planning, as well as the greater health coalition. Again, in the area that I live in, there are websites that are available. If you were to ever Google advanced care planning, advanced directives, it would pull up some different documents for you to do your own research on. And however, I'd always recommend a followup with your primary care physician to ensure that the information that you're reading is accurate and correct. And the most up to date.

Hanh: 28:10

So, do you have an incident that you could share that you met someone who was not pleased of how things turn out after they had conversations about their preferences for future life ending treatment? You know, you have a situation when people were not happy with it.

Brandy: 28:27

I can't say that I've had a situation where people weren't happy that they've had a conversation. I can say I've had situations I've worked in the hospital prior. One of my roles was having these conversations around advanced care planning and advanced directives. And I have found more times than not patients didn't realize they existed. They didn't know the importance of it. They didn't know what they do. And once they found out they're in the hospital, they're in crisis mode, they're getting ready to have a procedure, or maybe they're at end of life. They realized, they need to dig a little deeper. And then to these advanced care planning conversations, because they don't want their wishes to be unknown. They don't want their family to be under stress when that time comes. So what I tend to hear is when we start having those conversations with those patients says, I feel relieved that we're able to put this down on paper now on writing to ensure my wishes are fulfilled. So more so that they're happy to have the conversations. Haven't heard it, that they're not happy to have the conversation. But they found them to be beneficial.

Hanh: 29:29

Great. Great. So what do you think it's discouraging seniors from planning further ahead?

Brandy: 29:37

It's scary. Again, we go back to that conversation of you think about planning ahead and you think about death and you think about end of the life. And we don't always look at the bigger picture of this is in the event and it could be temporary that you're unable to make decisions for yourself. And those advanced care planning conversations in those advanced directives that we mentioned, they're only into play in the event that you can make, can not make those decisions yourself. As long as you are coherent and you're orientated, you can make the decisions, but it's just having that, that precaution or that extra formality in the event that you are unable to. So I think it just goes back to that fear.

Hanh: 30:15

Yeah, I agree. So who benefits from the advanced care plan, in addition to the, you know, the survivors and parents, and so forth?

Brandy: 30:25

So I will, I will really say the patients benefit the most because it is their wishes. They have that in writing and they're able to ensure that's being fulfilled. And then the healthcare workers that are involved with the patient's care. So if you're in a hospital, having that document directs the care that that patient's going to receive instead of everything being put on hold or maybe on necessary treatment or unwanted treatment being implemented, it would be known what the patient wants right away. And they're able to move and act on those documents and the patient's wishes. So the healthcare workers, the physician, all those involved in the overall patient's medical treatment.

Hanh: 31:02

Now, give me some specifics. What type of information would you want to have on your advanced care planning? And do you think this is something people should have done before their 80th birthday?

Brandy: 31:18

Absolutely. So once you turn 18, you should have an advance directive. You should be having advanced care conversations because anything can happen. There's no guarantees in some of the information you'd want to ensure that you have is around CPR, ventilator, use artificial nutrition, and that would consist of tube feeding as well as comfort care. And it really all depends on the comfort level and what that patient wants to talk about. I push advanced care conversations on my mom. We talk about it and it's, it's not a, once you create that document, it's done it's, you can change it as you go throughout life. You can change every couple of months. You can change it every year. You can change it every week. If you have a major change in your medical status, you can change that document to best fit your needs and your wants.

Hanh: 32:06

So where can people get an advanced care planning form and how much does it cost?

Brandy: 32:13

So you should be able to find them for free. The national Institute on aging has forms you again. You should be able to find advanced care planning, conversations, templates for that year form itself is going to be your advanced directive. You can print this off. Usually you just need two witnesses. They can not be family. A lot of hospitals do these. There's no charge associated with it. They would, if you're in the hospital and you let a case manager or a social worker know that you'd like to have some information around advanced care planning or advanced directives, they should have someone on staff to be able to come and meet with you while you're in the hospital, discuss it and provide you some forms. You don't have to complete it, but at least you've got that ball rolling.

Hanh: 32:53

Great. Great guys. Thank you so much. And do you have anything else that you would like to share?

Brandy: 32:58

I don't, I, I just think, you know, the preventative. Services out there that are available to seniors to the general population is really beneficial to those patients. It's really helpful to prevent medical conditions. From progressing and becoming worse conditions. And the focus is on quality of life and living. So I think it's really good. What services are available? I believe there's more knowledge about annual wellness visits, advanced care planning, preventative services in general than what there was 30 years ago. I really liked the shift that we're going into the value based in a way from the fee for service.

Hanh: 33:34

Very true. Well, whether you're listening or watching, I hope that, you know, you'll agree that preventative healthcare is an important part of living well. And by getting regular checkups and screenings, you can help prevent illness or detected early when treatment works best. And also annual wellness visits are the foundation of preventative health care. They're also a great opportunity for you to get to know your doctor and your family and discuss personalized prevention strategies. And if you have any questions, please message us, send us an email or something. And again, thank you so much for tuning in.